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Home My WebLink About16062-z FOUM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 16062 z Permission is hereby granted to: .~~.~....~.~.~.~.. ..4..~..-..~..-......~...~.'7...~ .................... .~..,,~...~....~...,.~..~.....u..,..?. to /"'0~~' 4..~T~......O~.~.~,. .... ,~...:,...~~ .., ....... .~~ .............................. at premises located at ~,.! ..~..~ County Tax Mop No. 1000 Section .... ..~..~...~,~t,. ....... Block .... ..~.....~ ........ Lot No....,.~...~. ............ pursuant to application dated ........... ..~......~......~....~m.. ........ , , 9...~....'], and approved by the Building Inspector. Fee $.~..~.:.,.....~.... .... Building Inspector Rev. 6/30/80 ~0 '\ '\ f 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~ t.~..., 19.~.~. Approved . ./.t~. , 19 BOARD OF HEALTH ...... 3 SETS OF/PLANS ....... SURVEY CHECK SEPTIC FORM ............. : NOTIFY CALL Disapproved a/c ..................................... ~;L~,G. .......... TOWJ~ OF 80U'F~OLD (Building Inspector) APPLICATION FOR BUI LDI NG PERM IT .~../~'~ ~ .// Date ...... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of~lans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- catioa. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c,od'E~d regulations, and to admit authorized inspectors on premises and in building for necessary i~// / ~ /-~eDi,~i~Oc'~'oDr-~f~'an- t, or nan/e, ~P'a co~oration) ( d . (Mailing address of applicant) State whether applicant ~s×owher,,Aessee, agent, architect, engineer, general cgntractclr, el&c'tnclan, plumber or bmlder. ......... ....... , ...., .............................. .......... Name of owner of premises .... r. :/.: ......... :.~/. ....... ~~/..~." ....... ] ...................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... on 1. Location of land which proposed work willie [d~one. K~--~..'~. x/. ..... ~..~...~.~....~. ~.. ~.~. · ........... House Number Street Hamlet County TaxMap No. I000 Section ..~ ........ Block ..~ ............. Lot .... ~ ............ Subdivision ..................................... Filed Map No. ZZ~. ~ ..... Lot.. ~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ~.~~ ..... ~~ .................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition. ............. Other Work. 1 ............. , (Descrip~tion) 4. Estimated Cost ...................... Fee ...................................... · ' ' ' ' ' (to be paid on filing this application) 5. If dwelling, number of dwelling !units ............... Number of dwelling units on each floor ................ If garage, number of cars .... , ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u'se '.; .... . .............. 7; Dimensions of existing structur{s, if any: Front....~ ........... Rear .............. Depth ............... tteight. · :; '4' ".' Number of Stories ...... ..... ~.. ................... ~...' ..................... Dimensions of same structure w.~th alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... ".8. Dimensions of entire new construction: Front .......... ~ ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ....................... Depth ...................... 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use d!strict in which prkmises are situated ..................................................... 12. Does p~opo~ed construction vio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ; ................... Will excess fill be removed from premises: Yes No 14, Name of Owner of premises ..; ................. Address ................... Phone No ................ Name of Architect ......... k ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address .... : .............. Phone No ................ 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... No ..... · Tf yes, Southold Town Tr6stees Permit maybe required. PLOT DIAGRAM ~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensi6ns from number or description according to deed, and show street names and indicate ~,hether "'".2) '~//~w' ~ ~/~7~ V, NOTI~ ~ILDING' DEPAR FOLLOWING iN~p[CTIONS: ~NDATION '~O ~EQUIRED ~UGH ~RAI~tNG ~ pLuMBING ~ C~N~I'~uCTIOi~ S~AI-L co~Y ov~. : s.S ~ T~.mu'"~"~?~ applicant above named. ' n. is t~. ..... ~. ~ ................................................................... ~ (Co~tractor, aggnt, corporate officer, etc.) of smd owner or owners ~d re'duly authorized to perform or have perfonned the sazd work and to m~e and file this applicatzon; that all statements conlmned m thru apphcat~on are true to the best of hm knowledge and belief; and that the work will be perfo~ed in the m~qer set forth in the application filed therewith. Sworn to before me this .... "../~ ............. ']~a~y ~r .... ~ ......... NotawPublic ..... w"'' · · · · '"' ........ C unty ~ ~ ~ . ON ~ ~: ~00~ . , ~ ~~' ' (Sig~u~ of applicant) ,~a~ ~,u~o. st,t. o~ .~ v~k~. ~ .. (. ~~v ' ~ -- ' - No~2563, Suffolk CounH~ t / ~ // mrm ~lres D~em~r 31, 19~ ~ ' / /r / property lines. Give street and bloc} interior or corner lot.